ADA Accommodation Request - Public Accommodation

ADA PUBLIC ACCOMMODATION — ACCOMMODATION REQUEST

I. Request to the business

Date: [__/__/____]

To: [OWNER OR OPERATOR NAME]

[BUSINESS NAME]

[STREET ADDRESS]

[CITY, STATE ZIP]

From: [REQUESTER NAME]

[ADDRESS]

[PHONE AND EMAIL]

Subject: Access request for [BUSINESS NAME] at [LOCATION]

Dear [OWNER OR MANAGER]:

I am requesting access to [GOODS, SERVICES, OR FACILITIES] at your [TYPE OF ESTABLISHMENT]. I have [DESCRIBE THE DISABILITY AND RELEVANT ACCESS NEED, WITHOUT UNNECESSARY MEDICAL DETAIL]. I understand that [BUSINESS NAME] is a [SPECIFIC CATEGORY AND SUBPARAGRAPH OF 42 U.S.C. § 12181(7)] whose operations affect commerce because [FACTS]. You [OWN / LEASE / OPERATE] this establishment.

On [DATE], I [VISITED / ATTEMPTED TO USE] [LOCATION OR SERVICE]. [DESCRIBE WHAT HAPPENED, THE BARRIER OR POLICY, AND HOW IT AFFECTED ACCESS]. [IDENTIFY EMPLOYEES OR COMMUNICATIONS IF RELEVANT]. I expect to use the establishment again on or about [DATE OR FREQUENCY], and the same issue would affect that visit.

I request the following measures under 42 U.S.C. § 12182(b)(2)(A), as applicable to these facts:

☐ Policy change: [SPECIFIC MODIFICATION NEEDED AND WHY IT IS NECESSARY TO OBTAIN ACCESS].

☐ Auxiliary aid or service: [SPECIFIC AID OR EFFECTIVE ALTERNATIVE NEEDED TO AVOID EXCLUSION OR UNEQUAL SERVICE].

☐ Existing-facility barrier removal: [DESCRIBE THE STRUCTURAL BARRIER AND PROPOSED REMOVAL; STATE FACTS BEARING ON WHETHER REMOVAL IS READILY ACHIEVABLE].

☐ Alternative method: [DESCRIBE THE METHOD REQUESTED IF BARRIER REMOVAL IS NOT READILY ACHIEVABLE AND THE METHOD IS READILY ACHIEVABLE].

Please respond by [DATE] with the measures you will take and the expected completion date. You may contact me at [CONTACT METHOD] to discuss an effective solution. Please preserve records relating to [INCIDENT AND ACCESS ISSUE].

Sincerely,

[REQUESTER OR AUTHORIZED REPRESENTATIVE SIGNATURE]

[PRINTED NAME]

II. Federal court complaint

UNITED STATES DISTRICT COURT FOR THE [DISTRICT] OF [STATE]

Case No.: [____________]

COMPLAINT FOR PREVENTIVE RELIEF UNDER TITLE III OF THE ADA

Plaintiff alleges:

1. Plaintiff [NAME] has [DESCRIBE THE IMPAIRMENT AND SUBSTANTIALLY LIMITED MAJOR LIFE ACTIVITY, OR A RECORD OF SUCH AN IMPAIRMENT, WITH FACTS SHOWING COVERAGE UNDER 42 U.S.C. § 12102]. Plaintiff needs [ACCESS MEASURE] to use Defendant's [GOODS OR SERVICES].
2. Defendant [NAME] [OWNS / LEASES / OPERATES] [ESTABLISHMENT] at [ADDRESS]. It is a private [SPECIFIC § 12181(7) CATEGORY AND SUBPARAGRAPH] whose operations affect commerce because [FACTS].
3. This Court has subject matter jurisdiction under 28 U.S.C. § 1331 because this claim arises under 42 U.S.C. § 12182. Title III provides a private action for preventive relief under 42 U.S.C. § 12188(a)(1).
4. Venue is proper under 28 U.S.C. § 1391(b)(2) because a substantial part of the events or omissions occurred in this district at [LOCATION AND FACTS].
5. On [DATE], Plaintiff [DESCRIBE VISIT, ATTEMPTED VISIT, OR ACTUAL NOTICE MAKING A VISIT FUTILE]. Defendant [DESCRIBE SPECIFIC CONDUCT, BARRIER, POLICY, OR MISSING AID]. As a result, Plaintiff [DESCRIBE DENIED OR UNEQUAL ACCESS].
6. Plaintiff intends to use [ESTABLISHMENT OR SERVICE] again [WHEN AND WHY], but [DESCRIBE CONTINUING BARRIER OR POLICY] will prevent or impair equal use unless corrected.
7. Defendant's conduct constitutes discrimination under the applicable provision(s) of 42 U.S.C. § 12182(b)(2)(A): [SELECT AND STATE FACTS FOR EACH APPLICABLE THEORY—(i) screening eligibility criterion; (ii) failure to make a necessary reasonable modification, subject to fundamental alteration; (iii) failure to provide necessary auxiliary aids or services, subject to fundamental alteration or undue burden; (iv) failure to remove an existing structural barrier where readily achievable; or (v) failure to provide a readily achievable alternative method where removal is not readily achievable].
8. [DESCRIBE NOTICE TO DEFENDANT, RESPONSE, AND FACTS SHOWING THE ISSUE PERSISTS, IF KNOWN].

Request for relief. Plaintiff requests an order requiring [SPECIFIC ACCESS MEASURES SUPPORTED BY THE PLEADED FACTS] to the extent required by 42 U.S.C. § 12188(a)(2), preventive relief authorized by § 12188(a)(1), and, if Plaintiff prevails, reasonable attorney's fees, litigation expenses, and costs in the Court's discretion under 42 U.S.C. § 12205.

Date: [__/__/____]

[PLAINTIFF OR ATTORNEY SIGNATURE]

[PRINTED NAME]

[ADDRESS]

[PHONE]

[EMAIL]

III. DOJ complaint letter

Date: [__/__/____]

To: U.S. Department of Justice

Civil Rights Division

950 Pennsylvania Avenue, NW

Washington, DC 20530

From: [COMPLAINANT NAME AND CONTACT DETAILS]

Subject: ADA Title III complaint concerning [BUSINESS NAME]

I report disability discrimination by [BUSINESS NAME AND ADDRESS], a [TYPE OF ESTABLISHMENT] [OWNED / LEASED / OPERATED] by [NAME].

I have [DESCRIPTION OF DISABILITY AND ACCESS NEED]. On [DATE(S)], [DESCRIBE THE INCIDENT, BARRIER, OR POLICY, PERSONS INVOLVED, AND EFFECT ON ACCESS]. [DESCRIBE ANY LATER ATTEMPTS, RESPONSES, OR CONTINUING PROBLEM]. I request that the Department review this matter under Title III of the ADA. I can provide [PHOTOS / CORRESPONDENCE / WITNESSES / OTHER RECORDS].

[COMPLAINANT SIGNATURE]

[PRINTED NAME]

Before use

☐ Identify the precise § 12181(7) category, the operator, and facts showing that the private entity's operations affect commerce. If the access issue concerns a website, describe its relationship to the covered establishment and evaluate the applicable law.

☐ Match each requested measure and complaint theory to the facts. For existing structural barriers, assess whether removal is readily achievable; consider § 12182(b)(2)(A)(v) if it is not.

☐ For a court complaint, state concrete facts showing ongoing or likely future harm and the basis for venue. Seek preventive relief under the federal Title III claim; assess any state claim separately before adding it.

☐ Retain dated communications and records of the access issue. Review the current DOJ submission instructions before sending Section III.

Sources and references

• 42 U.S.C. § 12102, § 12181, § 12182, and § 12188
• 42 U.S.C. § 12205
• 28 U.S.C. § 1331 and § 1391
• DOJ ADA complaint instructions